So I am a recently graduated RN working in a MSICU, and I deal with pretty much everything under the sun, but I figured this would be more appropriate as a neuro ICU thread.
I had a pt who was found unresponsive on the MS floor, coded, and was brought up to our units. He had not woken up at all after the code. We had him intubated and sedated and whatnot, and we noticed some seizure-like activity that was going on pretty much continuously. We got him all hooked up to the EEG and saw the seizures. I was wondering if the correct order of meds was really being given, as the MD was saying start propofol and get Ativan on board as a temporary measure until we could get Dilantin up froim pharmacy. We got all that on board and it was stopping the majority of the motor activity portion of the seizure but not the activity on the EEG. We even had started him on Levo because we had such a high rate of propofol going (Per the MD, he was up to around 100 mcgs). Even when we gave the Dilantin bolus he continued to show activity on the monitor and slight motor tremors. We moved to a Versed gtt, and titrated up on the Versed to more than the max than myself or the orienting nurse were acquainted with. The EEG tech and the neurologist stated that the ideal would be if we could see less than 3 bursts of activity on the monitor per minute, and we were nowhere close to that. The MD moved to the next step as a pentobarb coma, at which point it was the end of my shift so I didn't really get to see any resolution. The neurologist wanted an MRI to say with certainty that anoxic brain injury was the cause, but with the pt showing little response to any meds we didn't end up taking him down. This gentleman had no prior seizure hx, but did had end-stage Parkinson's. Anoxic brain injury was pretty much what the critical care MDs believed the seizures were coming from.
My question is, was there other meds that we could have been giving that would have been more effective? Is there any other course of tx that you experienced neuro RNs feel would have been more efficient? I felt like a fish out of water being new, and my orienting RN was also a bit lost because she had not used EEG monitoring as a baseline to titrate seizure meds. I'm hoping you guys will be able to give me a bit more info!